From the University of Louisville Department of Surgery (K.R.M., M.E.E., M.C.B., G.A.F., N.A.N., J.W.S., B.G.H., M.V.B.), University of Louisville School of Medicine; and University of Louisville Health, University of Louisville Hospital, Trauma Institute (A.P., J.B.), Louisville, Kentucky.
J Trauma Acute Care Surg. 2022 Jan 1;92(1):82-87. doi: 10.1097/TA.0000000000003367.
Current data on the epidemiology of firearm injury in the United States are incomplete. Common sources include hospital, law enforcement, consumer, and public health databases, but each database has limitations that exclude injury subgroups. By integrating hospital (inpatient and outpatient) and law enforcement databases, we hypothesized that a more accurate depiction of the totality of firearm injury in our region could be achieved.
We constructed a collaborative firearm injury database consisting of all patients admitted as inpatients to the regional level 1 trauma hospital (inpatient registry), patients treated and released from the emergency department (ED), and subjects encountering local law enforcement as a result of firearm injury in Jefferson County, Kentucky. Injuries recorded from January 1, 2016, to December 31, 2020, were analyzed. Outcomes, demographics, and injury detection rates from individual databases were compared with those of the combined collaborative database and compared using χ2 testing across databases.
The inpatient registry (n = 1,441) and ED database (n = 1,109) were combined, resulting in 2,550 incidents in the hospital database. The law enforcement database consisted of 2,665 patient incidents, with 2,008 incidents in common with the hospital database and 657 unique incidents. The merged collaborative database consisted of 3,207 incidents. In comparison with the collaborative database, the inpatient, total hospital (inpatient and ED), and law enforcement databases failed to include 55%, 20%, and 17% of all injuries, respectively. The hospital captured nearly 94% of survivors but less than 40% of nonsurvivors. Law enforcement captured 93% of nonsurvivors but missed 20% of survivors. Mortality (11-26%) and injury incidence were markedly different across the databases.
The utilization of trauma registry or law enforcement databases alone do not accurately reflect the epidemiology of firearm injury and may misrepresent areas in need of greater injury prevention efforts.
Epidemiological, level IV.
目前美国有关枪支伤害流行病学的数据并不完整。常见的来源包括医院、执法部门、消费者和公共卫生数据库，但每个数据库都有其局限性，排除了某些伤害亚组。通过整合医院（住院和门诊）和执法数据库，我们假设可以更准确地描述我们地区枪支伤害的全貌。
我们构建了一个合作的枪支伤害数据库，其中包括所有因枪支伤害被收入肯塔基州杰斐逊县地区一级创伤医院（住院患者登记）的住院患者、在急诊部（ED）接受治疗和出院的患者，以及因枪支伤害被当地执法部门遇到的患者。分析了 2016 年 1 月 1 日至 2020 年 12 月 31 日期间记录的伤害。比较了各数据库的结局、人口统计学特征和伤害检出率，并通过 χ2 检验进行了比较。
住院患者登记（n=1441）和 ED 数据库（n=1109）合并后，医院数据库中共有 2550 例事件。执法数据库包括 2665 例患者事件，其中 2008 例与医院数据库有共同事件，657 例为独特事件。合并后的合作数据库包括 3207 例事件。与合作数据库相比，住院患者、全院（住院和 ED）和执法数据库分别遗漏了所有伤害的 55%、20%和 17%。医院捕获了近 94%的幸存者，但不到 40%的非幸存者。执法部门捕获了 93%的非幸存者，但错过了 20%的幸存者。死亡率（11-26%）和伤害发生率在各数据库之间存在显著差异。
仅使用创伤登记处或执法数据库不能准确反映枪支伤害的流行病学情况，可能会错误地描述需要加强伤害预防工作的领域。
流行病学，四级。
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